We seek to continue our population-based study of stroke incidence, risk factors, treatment, and outcome of stroke within our biracial metropolitan population of 1,349,351, of whom 215,611 (15%) are of black race (US Census 2000). We have studied trends in stroke incidence and case fatality, as well as the prevalence of risk factors and knowledge of stroke (via a population survey) for almost 15 years and have demonstrated a racial disparity where stroke incidence in African-Americans is more than double that of whites. In addition to continuing these important activities, we propose an innovative pilot study that will be the largest prospective, population-based stroke outcomes study to date. The anticipated ~3,200 patients with strokes and 800 TIAs from our region in 2010, as well as the 2,000 surveyed participants, will be used to test the following hypotheses: 1. Temporal trends in the incidence rate of stroke will demonstrate a decrease over time in whites (as shown by our 2005 preliminary data). However, there will not be a similar decrease among blacks, a racial group that has not been examined in other temporal studies of stroke. We expect that case fatality rates will not change between periods, and will be similar for both blacks and whites. 2. A cohort of subjects followed by a regional HIE combined with phone-call follow-up will be more representative of the entire stroke population in our region than a cohort of subjects that agree to in-person interviews, which is likely to have participation and survival biases. Information obtained via this approach will be as valid as data from manual chart abstraction and direct interview for determining access to care and individual patients' functional outcome after stroke across a region, and will be more efficient to collect than that obtained via manual processes. 3. The proportion of the population that knows warning signs or risk factors for stroke will NOT improve between 2006 and 2011, based on our preliminary data. When subjects are asked about their own personal risk for stroke, a lower self-perceived risk will be associated with worse stroke knowledge. PUBLIC HEALTH RELEVANCE: The change in stroke occurrence over time is the ultimate test of how well science has translated new discoveries into benefits for the population. Our study has examined racial disparities in stroke over the last 15 years, showing that blacks have higher risk for stroke than whites. In our population, the occurrence of stroke is decreasing in whites but not African Americans, and we will continue to describe trends in stroke occurrence, cause, treatment, and outcome in a biracial metropolitan population.